LCD L39849: Opioid Treatment Programs

A59718: Billing and Coding: Opioid Treatment Programs (Billing and Coding, effective 2026-01-01)

Covered ICD-10-CM codes

39

1 group

Non-covered ICD-10-CM codes

299

Procedure codes listed

20

Full article

cms.gov record

Procedure codes: G0137 (Intensive Outpatient Services; Weekly Bundle, Minimum Of 9 Services Over A 7 Contiguous Day Period, Which Can Include Individual And Group Therapy With Physicians Or Psychologists (Or Other Mental Health Professionals To The Extent Authorized Under State Law); Occupational Therapy Requiring The Skills Of A Qualified Occupational Therapist; Services Of Social Workers, Trained Psychiatric Nurses, And Other Staff Trained To Work With Psychiatric Patients; Individualized Activity Therapies That Are Not Primarily Recreational Or Diversionary; Family Counseling (The Primary Purpose Of Which Is Treatment Of The Individual'S Condition); Patient Training And Education (To The Extent That Training And Educational Activities Are Closely And Clearly Related To Individual'S Care And Treatment); Diagnostic Services; And Such Other Items And Services (Excluding Meals And Transportation) That Are Reasonable And Necessary For The Diagnosis Or Active Treatment Of The Individual'S Condition, Reasonably Expected To Improve Or Maintain The Individual'S Condition And Functional Level And To Prevent Relapse Or Hospitalization, And Furnished Pursuant To Such Guidelines Relating To Frequency And Duration Of Services In Accordance With A Physician Certification And Plan Of Treatment (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); List Separately In Addition To Code For Primary Procedure), G0532 (Take-Home Supply Of Nasal Nalmefene Hydrochloride; One Carton Of Two, 2.7 Mg Per 0.1 Ml Nasal Sprays (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program);( List Separately In Addition To Each Primary Code)), G0533 (Medication Assisted Treatment, Buprenorphine (Injectable) Administered On A Weekly Basis; Weekly Bundle Including Dispensing And/Or Administration, Substance Use Counseling, Individual And Group Therapy, And Toxicology Testing If Performed (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program)), G0534 (Coordinated Care And/Or Referral Services, Such As To Adequate And Accessible Community Resources To Address Unmet Health-Related Social Needs, Including Harm Reduction Interventions And Recovery Support Services A Patient Needs And Wishes To Pursue, Which Significantly Limit The Ability To Diagnose Or Treat An Opioid Use Disorder; Each Additional 30 Minutes Of Services (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); (List Separately In Addition To Each Primary Code)), G0535 (Patient Navigational Services, Provided Directly Or By Referral; Including Helping The Patient To Navigate Health Systems And Identify Care Providers And Supportive Services, To Build Patient Self-Advocacy And Communication Skills With Care Providers, And To Promote Patient-Driven Action Plans And Goals; Each Additional 30 Minutes Of Services (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); (List Separately In Addition To Each Primary Code)), G0536 (Peer Recovery Support Services, Provided Directly Or By Referral; Including Leveraging Knowledge Of The Condition Or Lived Experience To Provide Support, Mentorship, Or Inspiration To Meet Oud Treatment And Recovery Goals; Conducting A Person-Centered Interview To Understand The Patient'S Life Story, Strengths, Needs, Goals, Preferences, And Desired Outcomes; Developing And Proposing Strategies To Help Meet Person-Centered Treatment Goals; Assisting The Patient In Locating Or Navigating Recovery Support Services; Each Additional 30 Minutes Of Services (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); (List Separately In Addition To Each Primary Code)), G1028 (Take-Home Supply Of Nasal Naloxone; 2-Pack Of 8Mg Per 0.1 Ml Nasal Spray (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); List Separately In Addition To Code For Primary Procedure), G2067 (Medication Assisted Treatment, Methadone; Weekly Bundle Including Dispensing And/Or Administration, Substance Use Counseling, Individual And Group Therapy, And Toxicology Testing, If Performed (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program)), G2068 (Medication Assisted Treatment, Buprenorphine (Oral); Weekly Bundle Including Dispensing And/Or Administration, Substance Use Counseling, Individual And Group Therapy, And Toxicology Testing If Performed (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program)), G2069 (Medication Assisted Treatment, Buprenorphine (Injectable) Administered On A Monthly Basis; Bundle Including Dispensing And/Or Administration, Substance Use Counseling, Individual And Group Therapy, And Toxicology Testing If Performed (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program)), G2073 (Medication Assisted Treatment, Naltrexone; Weekly Bundle Including Dispensing And/Or Administration, Substance Use Counseling, Individual And Group Therapy, And Toxicology Testing If Performed (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program)), G2074 (Medication Assisted Treatment, Weekly Bundle Not Including The Drug, Including Substance Use Counseling, Individual And Group Therapy, And Toxicology Testing If Performed (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program)), G2075 (Medication Assisted Treatment, Medication Not Otherwise Specified; Weekly Bundle Including Dispensing And/Or Administration, Substance Use Counseling, Individual And Group Therapy, And Toxicology Testing, If Performed (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program)), G2076 (Intake Activities, Including Initial Medical Examination That Is Conducted By An Appropriately Licensed Practitioner And Preparation Of A Care Plan, Which May Be Informed By Administration Of A Standardized, Evidence-Based Assessment, And That Includes The Patient'S Goals And Mutually Agreed-Upon Actions For The Patient To Meet Those Goals, Including Harm Reduction Interventions; The Patient'S Needs And Goals In The Areas Of Education, Vocational Training, And Employment; And The Medical And Psychiatric, Psychosocial, Economic, Legal, Housing, Physical Activity And/Or Nutrition Needs And Other Recovery Support Services That A Patient Needs And Wishes To Pursue, Conducted By An Appropriately Licensed/Credentialed Personnel (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); List Separately In Addition To Each Primary Code), G2077 (Periodic Assessment; Assessing Periodically By An Otp Practitioner And Includes A Review Of Moud Dosing, Treatment Response, Other Substance Use Disorder Treatment Needs, Responses And Patient-Identified Goals, And Other Relevant Physical, Nutrition And Psychiatric Treatment Needs And Goals; May Be Informed By Administration Of A Standardized, Evidence-Based Assessment, Or The Need And Interest For Harm Reduction Interventions And Recovery Support Services (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); List Separately In Addition To Each Primary Code), G2078 (Take-Home Supply Of Methadone; Up To 7 Additional Day Supply (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); List Separately In Addition To Code For Primary Procedure), G2079 (Take-Home Supply Of Buprenorphine (Oral); Up To 7 Additional Day Supply (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); List Separately In Addition To Code For Primary Procedure), G2080 (Each Additional 30 Minutes Of Counseling In A Week Of Medication Assisted Treatment, (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); List Separately In Addition To Code For Primary Procedure), G2215 (Take-Home Supply Of Nasal Naloxone; 2-Pack Of 4Mg Per 0.1 Ml Nasal Spray (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); List Separately In Addition To Code For Primary Procedure), G2216 (Take-Home Supply Of Injectable Naloxone (Provision Of The Services By A Medicare-Enrolled Opioid Treatment Program); List Separately In Addition To Code For Primary Procedure).